consultation - ftg 2012
TRANSCRIPT
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CONSULTATION &DOCUMENTS
FTM 5TH EDCHAPTERS 2, 4 & 9
Swedish Massage
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Texas DSHS RequirementsDesigning Your Consultation Form
Consultation & Documents
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Requirements of TexasDSHS
Written Consultation Form
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§140.304. Consultation Document
(a) A licensee shall provide an initial
consultation to each client(s) prior to the
first massage therapy session and obtain
the signature of the client on theconsultation document. The consultation
document shall include:
(1) the type of massage therapy services or
techniques the licensee anticipates using
during the massage therapy session;
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§140.304. Consultation Document
(2) the parts of the client's body that will bemassaged or the areas of the client's body thatwill be avoided during the session, includingindications and contraindications;
(3) a statement that the licensee shall notengage in breast massage of female clientswithout the written consent of the client;
(4) a statement that draping will be usedduring the session, unless otherwise agreedto by both the client and the licensee;
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§140.304. Consultation Document
(5) a statement that if uncomfortable for
any reason, the client may ask the licensee
to cease the massage and the licensee will
end the massage session; and
(6) the signature of both the client and the
licensee.
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§140.304. Consultation
Document
(b) If the client's reason for seeking
massage therapy changes at any time and
any of the information in subsection (a)(1) -
(4) of this section is modified, the licenseemust provide an updated consultation
reflecting any changes and modifications
to the techniques used or the parts of the
client's body to be massaged.
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§140.304. Consultation Document
§140.303. General Ethical Requirements
(e) For each client, a licensee shall keep
accurate records of the dates of massage
therapy services, types of massage therapy
and billing information. Such records must
be maintained for a minimum of two years.
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Client InformationPertinent Information
Designing Your Consultation
Form
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Designing Your Consultation Form
Length: Is more than 1 page
necessary?
Time to complete: will it take morethan 10 minutes?
Readability: Type size large enough?
Organization: Does it flow well or havea logic to the arrangement?
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Designing Your Consultation Form
Convenient: Can items that apply be
circled or checked off
Necessary: Do you as a therapist need to
know this?
Flexible: Is there room for them to add
information they feel you need to know?
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Client Information
Name & Address
Home, work & cell numbers, email
address
Who is responsible for payment
Emergency contact
Date of birth/age, sex Referring individual
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Possible Additional Client
Information
Occupation
Hobbies
Social security numberTexas Drivers License Number
Marital status, number of children
Height & weight Any other information?
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Pertinent Information
Date of appointment
Purpose of visit
Discomfort/pain levelsFocus areas
Areas to avoid
Medical history includingmedications, surgeries, past injuries
& major illnesses
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FTM pp. 137-141
Fig 4-16 Sample History Form
Fig 4-17 Sample Physical Assessment Form
Sample Forms:
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Booking the Appointment
Your Preparations for the Massage
First Appointment
Performing the Massage
After the Massage
Next Appointment
Initial Consultation
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PhoneWebsite
Booking the Appointment
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Our First Contact with the
Client
Phone
Smile when answer the phone
Professional greeting for voice mails –
return calls within 24 hrs or sooner Purpose of the visit?
Is this his first professional massage?Does she have any previous experienceswith massage?
How did you find out about my services?
Explain your professional services & fees
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Our First Contact with the
Client
Explain pertinent policies – can also be
on website
Request that she come 20 minutes early
to complete paperwork for the first
appointment
Can include form on website & request
that it be returned to you prior to the
appointment
Confirm appointment – call, email, text
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Your Preparations
General considerations: temperature, fresh air
& ventilation, privacy, accessibility, lighting,
aroma/scents, hygiene, warm hands
Prepare room/office – temperature,cleanliness, water, music
Prepare table – fresh linens, table warmer
turned on, face rest cover Prepare for massage – lubricant, holster,
pillows/bolsters, extra blanket
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First Appointment
GreetingProfessional
Friendly
Eye contact Completion of intake form/medical history – allow 10 minutes
You ask the questions to complete the formor
You give them the form to complete
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Handshake?
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First Appointment
Determine ifindications orcontraindicationsexist
Observation of posture,gait, & generaldemeanorCommunication &
listening skillsObserve client’s non-
verbal language
Notice any touching ofbody parts during thediscussion – can be
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Sample Questions - Chief Concern or
Priorities
What is your major concern today? Any other areasof concern or pain?
What type of massage do you prefer? Relaxation,deep tissue, other?
What results do you want from your massagesession? What would you like to achieve with ourwork?
Is there an area where you would like extra time
spent? Any area where you seem to hold a lot oftension?
How do you use your body during the day?
Examples: how much time spent per day standing,
sitting, chasing small children, carrying heavy items,etc?
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Sample Questions - Soft Tissue
Conditions
Do you follow a regular exercise program? What kind?
Do you use alcohol, coffee or tea? Is your use heavy,moderate or light?
What are your frequent activities? Occupation?
What are your sleep habits? Hours & quality of sleepmost nights, difficulties? What is your sleep position? Isyour mattress comfortable?
What is your diet like?
Do you use orthotics such as heel lifts, sole lifts, archsupports, or inner soles?
How many glasses of water per day?
Current level of stress in your life? Currently in a periodof prolonged stress?
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Sample Questions - Stress
In which part of your body do you feel stress mostoften? Head, neck, shoulder, back, digestive,extremities, or other?
What portion of each day is set aside forrelaxation? What kind?
Do you use anything specifically for stressreduction? Examples: prayer, meditation, guided
imagery, exercise, energetic therapies, or other. Have you ever had a massage before? What is
your previous experience with professionalmassage?
Do you have a music or aroma preference?
S l Q ti
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Sample Questions -
Symptoms
What is your primary symptom? Any othersignificant symptoms? Examples: headaches,fatigue, depression, pins and needles, painful joints, loss of balance, stiffness, loss of strength,edema, constipation, diarrhea, heartburn, etc.
If pain, what is the pain like?
How severe or uncomfortable is the symptom for
you? What is the location of your symptom? How much
of your body is affected?
What is the onset? When did your problem
begin? When did you first notice it? What brought
S l Q ti
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Sample Questions -
Symptoms
What makes it worse? How long does it last?
Is the symptom getting progressively worse?
Is it constant or intermittent (comes and goes)?
Is there a pattern? Describe one episode – number of times per hour,
day, week, or month
What activities help or make the symptom worse?
What activities have you had to alter, decrease orstop? Examples: housekeeping, self-care, childcare, work, sleep
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Sample Questions - Mobility & Ability to
Perform Various Activities
What have you done to get relief? What homeremedies have you used to get relief?
What body positions are most comfortable? Do
you use over the counter medications? Whichones? In general, what makes the pain better?
Have you been or are you under a physician’scare for this symptom? Has there been a
diagnosis? Do you have a recommendation or aprescription for massage?
What does this problem mean to you?(Opportunity for client to express any feelings or
emotions surrounding the problem.)
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First Appointment
Determine client’s goal for the
massage
What must be done to achieve it?
Is the client’s goal reasonable?
Jointly determine plan for the massage
– allow 10-15 minutes
Determine pressure preferences, focus
areas, areas to avoid
Determine modalities to be used
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First Appointment
Informed consent and her signature(pp. 46-47;p. 50 Box 2-10) Get agreement from your client regarding what
modalities and techniques you will be using.Stress that if she doesn’t like something you do duringthe massage to let you know so that you can modify itor stop doing it.
If you need to work close to the breasts, groin or
gluteals, explain why and how you will drape the area. Consider having a written explanation of the services
you offer, along with a listing of their benefits and risks,if any. Give this to every new client. Ensure they havetime to read it & ask questions before you start
working with them.
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Informed Consent Form
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An informed consent contains information
from which the client
A. Can judge the practitioner
B. Can state the rights to reschedule thetreatment
C. Are advised of undesirable effects from
the massage D. Have decision-making rights
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An informed consent contains information
from which the client
D. Have decision-making rights
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Informed consent can be ___ at any time.
A. Modified
B. Ignored
C. Withdrawn
D. Both A and C
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Informed consent can be ___ at any time.
D. Both A and C
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A care plan is
A. A list of contraindications
B. A list of mutually agreeable goals and
course of treatment decided upon betweenclient and therapist
C. An assessment
D. Session notes
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A care plan is
B. A list of mutually agreeable goals and
course of treatment decided upon betweenclient and therapist
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First Appointment
Explain massage procedure
Facilities – where change clothes, restroom
Explain draping procedures
Level of undress for massageHow to get on & off table
How to position themselves on table
Use of pillows and bolsters forpositioning/support
Purpose & choice of lubricant – anyallergies?
Temperature preferences & use of blanket/s
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Performing the Massage
Modify pressure, plan & modalities as
needed
Explain why the modification is needed and
get her approval. Tell her that if she doesn’t
like the modification, you will stop doing it.
Client Feedback During
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Client Feedback During
Massage
Slower, deeper
breathing Relaxing of muscles
Verbal feedback
Snoring!
Fidgeting
Tensing muscles Facial flinching
Making a fist
Holding his/herbreath
Ways indicate enjoyment Ways indicate discomfort
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Performing the Massage
Ask questions about anything you
encounter such as scars, etc. not already
on intake sheet.
Document changes while waiting for client
to dress
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After the Massage
Ask her about her perceptions of changes in
focus areas – what worked & what didn’t
Ask if there was anything that he would have
liked you to have done differently
Give your suggestions for changes in next
massage based on your observations
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After the Massage
Provide suggestions about
Drinking water
Stretches to be done at home
Frequency of massage
Referrals to other professionals if needed
Schedule the next massage
Walk her out of your office Complete your session notes
Client feedback form
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Which is a skill for developing an optimal
client relationship?
A. Acceptance
B. Ignoring
C. Listening
D. Humoring
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Which is a skill for developing an optimal
client relationship?
C. Listening
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What is the first step in beginning massage
treatment?
A. Apply lubricant
B. Effleurage
C. Determine indications/contraindications
D. Diagnose the patient
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What is the first step in beginning massage
treatment?
A. Apply lubricant
B. Effleurage
C. Determine indications/contraindications
D. Diagnose the patient
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Follow-up after the Massage
Within next 2 days, contact client by phone,
email, or text to ask about changes in focus
areas
Document your discussion in session notes
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Next Appointment
Prior to client’s arrival – reread session notes
Discussion:
How did she do in between appointments
regarding previous goal/focus area? Any changes in goal, focus areas, & areas to
avoid?
Any new indications or contraindications?
Revise intake form to reflect any changes
Jointly determine plan for today’s massage – informed consent
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Planning single and multiple sessions
A. Is not easy to accomplish initially
B. Depends on client history and interview
C. Depends on the emotional status of the
client
D. Can only be effective after 6 visits
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Planning single and multiple sessions
B. Depends on client history and interview
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Massage Documents
Diagrams p. 138
Fig 4-18 Sample Treatment Plan p. 140
HIPAA Act - pp. 51-2 Box 2-11
Self-report forms
Diagrams – indicate where pain/discomfort felt
Document symptom occurrence & severity
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Body Diagrams & Pain Scales
A way for clients to
indicate focusareas and areas to
avoid
Can indicate pain
levels of differentareas of body
A way for clients to
document their levelof pain
Body Diagrams Pain Scales
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Body Diagrams
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Pain Scale
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Release of Information
Completed by the client to allow you to share
information with his/her health care provider
Includes your name and the client’s name
Includes name of person information will bereleased to and a time frame if necessary
Only exception to first completing a release
of information form is to respond to a court
order
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Release of Information
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FTM pp. 292-3
Client Feedback
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Sample Client Feedback Questions
Ask client to rate questions on scale of 1-5
where 1 is poor and 5 is excellent.
The overall atmosphere, cleanliness, and
quality of the facility was professional andrelaxing.
My massage therapist was friendly,
knowledgeable, and professional.
My therapist started and finished the session
on time.
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Sample Client Feedback Questions
My therapist consulted with me about the type of
massage I wanted to receive, the degree of
pressure I enjoy, and the areas of the body I wanted
focused work. We had an agreed upon plan for the
session before the start of the massage.
The therapist followed the session plan we agreed
on and I received the massage I requested.
My therapist asked about the degree of pressure ofstrokes and adjusted the pressure appropriately
when asked.
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Sample Client Feedback Questions
The massage strokes felt firm, flowing, and
appropriate to the needs of my body.
Draping, positioning, lighting, music, and my
overall warmth and comfort were attended to. My payment was processed in a timely
manner and I was given the opportunity to
book a future appointment at the end of the
session.
My overall experience was excellent and I
would come back.
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Session Notes
S i N t
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Session Notes
Progress Reports:
Used to report back to the referring physician
SOAP Notes:
PP. 138-142
Fig 4-19 Sample SOAP Notes p. 141
SOAP N t
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SOAP Notes
SOAP
S = Subjective
O = Objective
A = Assessment/Analysis/Application
P = Plan
Most popular charting system for health
care professionals
SOAP F
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SOAP Forms
Box 4-6 SOAP and Massage p.
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Box 4 6 SOAP and Massage p.
142
E l f SOAP i M
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Example of SOAP in Massage
Box 4-6 p. 142
S: hand placement, pain level
O: elevated shoulders, ROM of neck, pain
when touched, upper trapezius feels warm Approach: focus and strokes used
A: level of pain reduction, ROM of neck,
palpation results, effective strokes, cold feet P: exercises, next appointment, expected
number of sessions, talk with personal
physician re massage
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A client comes in and reports that herlower back has been hurting ever since she
mowed her yard yesterday. In which
section of the SOAP notes is thisinformation recorded?
A. S
B. O
C. A
D. P
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A client comes in and reports that herlower back has been hurting ever since she
mowed her yard yesterday. In which
section of the SOAP notes is thisinformation recorded?
A. S
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Communication between therapist andclient during a massage session should be
kept
A. To a minimum
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The confidential information about theclient can include:
A. Information during a session
B. Observations made by a therapist abouta physical or emotional condition
C. Health history
D. All of the above
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The confidential information about theclient can include:
D. All of the above
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Subjective information is obtained by
A. Assessing the way the client walks
B. Palpation
C. Assessing the way the client stands
D. Listening
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Subjective information is obtained by
D. Listening
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IN CLASS ACTIVITY
SOAP Notes Activity
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SOAP Notes Activity
Read case study of Mona’s condition and
her massage
Record information in appropriate
categories of S, O, A & P.
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Answer Key
SOAP Activity
Subjective
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Subjective
Symptoms
Diagnosed with frozen right shoulder
Currently receiving physical therapy for shoulder
Has shoulder pain, tension in neck & shoulders &numbness in 3rd & 4th fingers of right hand
Has limited use of her right arm
Can’t do things like hook/unhook her bra
Subjective
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Subjective
Client goals:
She wants massage to assist in her recovery
She wants a full body massage with focus on
neck & shoulders. She wants firm pressure but is more sensitive in
her right arm & shoulder.
Objective
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Objective
Observation:
Her right shoulder appears to be slightly
protracted in sitting posture
While palpating her neck & shoulders, musclesfeel tight
Objective
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Objective
Treatment goals Will confirm possible right shoulder protraction
Will focus on right Pectoralis major & minor to relieveshoulder protraction
Will use Swedish massage & trigger points to workright trapezius & underlying muscles to addressnumbness due to possible nerve compression
Will use reflexology to treat shoulder points on rightfoot
Mona will do any movements required of right arm
Full body massage with firm pressure with a focus onher neck & shoulders
Applications
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Applications
Massage Treatment Given
Confirmed protraction of right shoulder
Provided Swedish massage & trigger point work
to neck & shouldersUsed reflexology on shoulder points
Received normal massage on rest of body
Required more time to roll over due to her need to
protect the right shoulder
Applications
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Applications
Changes due to massage:
States that her neck & shoulder feel less tense
States that numbness has ‘disappeared’
Planning
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Planning
Homework Mona to ask her physical therapist about home use of hot/cold
packs
Mona already has daily home exercises from her physicaltherapist
Plan for next session Mona will return in 1 week for another massage
Will ask for input re tension & numbness in neck & shoulders
Will repeat Swedish & trigger point techniques as well asreflexology on shoulder points
Will evaluate the possibility of side-lying position for protractedshoulder
Long-term goals: